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. 2020 Mar 16;17(6):1928.
doi: 10.3390/ijerph17061928.

The Impact of Business Cycle on Health Financing: Subsidized, Voluntary and Out-of-Pocket Health Spending

Hao Dong  1 , Zhenghui Li  2 , Pierre Failler  3
Affiliations

The Impact of Business Cycle on Health Financing: Subsidized, Voluntary and Out-of-Pocket Health Spending

Hao Dong et al. Int J Environ Res Public Health. .

Abstract

Diverse types of healthcare systems in countries offer opportunities to explore the heterogeneous sources of health financing. This paper widely explores the effect of the business cycle on subsidized, voluntary and out-of-pocket health spending in 34 countries with different types of healthcare systems, by the methodology of hierarchical linear modeling (HLM). We use a panel of annual data during the years from 2000 to 2016. It further examines the business cycle-health financing mechanism by inquiring into the mediating effect of external conditions and innovative health financing, based on the structural equation modeling (SEM). The empirical results reveal that the business cycle harms subsidized spending, whereas its effect on voluntary and protective health spending is positive. Results related to the SEM indicate that the mediating effect of external conditions on the relationship between the business cycle and health financing is negative. However, we find that the business cycle plays a positive effect on health financing through innovative health financing channels. Thus, designing and implementing efforts to shift innovative health financing have substantial effects on the sustainability of healthcare systems.

Keywords: business cycle; health financing; hierarchical linear model; structural equation modeling; subsidized; voluntary and out-of-pocket health spending.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The logical organization of this paper.
Figure 2
Figure 2
Hypothetical model.
Figure 3
Figure 3
The effect of the business cycle on different types of health financing.
Figure 4
Figure 4
The initial structural model for global health financing.
Figure 5
Figure 5
The mediating effect of external conditions in countries with high-type systems.
Figure 6
Figure 6
The mediating effect of external conditions in countries with middle-type systems.
Figure 7
Figure 7
The mediating effect of external conditions in countries with the low-type system.
Figure 8
Figure 8
The mediating effect of innovative health financing in countries with high-type systems.
Figure 9
Figure 9
The mediating effect of innovative health financing in countries with middle-type systems.
Figure 10
Figure 10
The mediating effect of innovative health financing in countries with low-type systems.
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